Post-dural puncture headache (PDPH) is one of the most relevant complications that can occur after a dural puncture. The gold standard technique for treating PDPH is known as the blood patch. A systematic review of the scientific literature with a meta-analytic study was conducted and previously registered in the PROSPERO. It aimed to study the effectiveness of the blood patch as a first-choice treatment in patients with PDPH. The review followed the recommendations of the PRISMA. A guiding question was formulated following the acronym PICO. The research and preliminary screening strategy were conducted in three databases: Medline, Cochrane, and the Regional Portal of the VHL. The selection criteria were randomized clinical trials that evaluated the blood patch’s effectiveness in treating PDPH. For data collection and analysis, two authors independently selected studies, assessed the risk of bias, and extracted data. The primary outcome was the effectiveness rate of using the blood patch. Following the meta-analysis, an analysis of the certainty of the evidence was conducted. Our electronic search data resulted in 1118 studies; three were included in the meta-analysis. The blood patch has a favorable effect compared to placebo or other drug interventions in reducing headaches associated with PDPH.
References
[1]
Rodríguez-Camacho, M., Guirado-Ruiz, P.A. and Barrero-Hernández, F.J. (2023) Risk Factors in Post-Dural Puncture Headache. Revista Clínica Española, 223, 331-339. https://doi.org/10.1016/j.rce.2023.03.006
[2]
Amorim, J.A. (2012) Cefaleia pós-punção dural: Características clínicas e critérios para o diagnóstico. Ph.D. Thesis, Universidade Federal de Pernambuco.
[3]
Feitoza, L.R.B., de Souza, A.T.B. and da Silva Fernandes, D.R. (2021) Cefaleia pós-punção dural em cesariana: Fatores de risco associados e novas perspectivas sobre condutas medicamentosas. Revista Eletrônica Acervo Saúde, 13, e9127. https://doi.org/10.25248/reas.e9127.2021
[4]
Buddeberg, B.S., Bandschapp, O. and Girard, T. (2019) Post-Dural Puncture Headache. Minerva Anestesiologica, 85, 543-553. https://doi.org/10.23736/S0375-9393.18.13331-1
[5]
Paschoal, A.P., Vilaça, M.P., da Silva Rodrigues Machado, A.R., da Silva K.R.T., S.R., Gazarini, L. and da Silva, A.V. (2020) Cefaleia pós-punção dural-uma revisão de literatura. Brazilian Journal of Health Review, 3, 12153-12168. https://doi.org/10.34119/bjhrv3n5-062
[6]
Bezov, D., Ashina, S. and Lipton, R. (2010) Post-Dural Puncture Headache: Part II—Prevention, Management, and Prognosis. Headache, 50, 1482-1498. https://doi.org/10.1111/j.1526-4610.2010.01758.x
[7]
Fan, Y.T., Zhao, T.Y., Chen, J.H., Tang, Y.L. and Song, X.R. (2023) Prophylactic Epidural Blood Patch or Prophylactic Epidural Infusion of Hydroxyethyl Starch in Preventing Post-Dural Puncture Headache—A Retrospective Study. Pain Physician Journal, 26, 485-493. https://doi.org/10.36076/ppj.2023.26.485
[8]
Waschke, J. (2019) Sobotta Anatomia Clínica. Elsevier.
[9]
Uppal, V., Russell, R., Sondekoppam, R.V., et al. (2023) Evidence-Based Clinical Practice Guidelines on Postdural Puncture Headache: A Consensus Report from a Multisociety International Working Group. Regional Anesthesia & Pain Medicine, 49, 471-501.
[10]
Turnbull, D.K. and Shepherd, D.B. (2003) Post-Dural Puncture Headache: Pathogenesis, Prevention and Treatment. British Journal of Anaesthesia, 91, 718-729. https://doi.org/10.1093/bja/aeg231
[11]
Bicket, M.C., Peahl, A. and Gaiser, R.R. (2023) Improving the Management of Postdural Puncture Headache—An International Clinical Guideline and Call for Better Evidence. JAMA Network Open, 6, e2325348. https://doi.org/10.1001/jamanetworkopen.2023.25348
[12]
Shear, T. (2008) Epidural Blood Patch for Chronic Daily Headache with Postural Component: A Case Report and the Review of Published Cases. Pain Physician Journal, 11, 77-80. https://doi.org/10.36076/ppj.2008/11/77
[13]
Kwak, K.H. (2017) Postdural Puncture Headache. Korean Journal of Anesthesiology, 70, 136-143. https://doi.org/10.4097/kjae.2017.70.2.136
[14]
Van Kooten, F., Oedit, R., Bakker, S.L.M. and Dippel, D.W.J. (2008) Epidural Blood Patch in Post Dural Puncture Headache: A Randomised, Observer-Blind, Controlled Clinical Trial. Journal of Neurology, Neurosurgery and Psychiatry, 79, 553-558. https://doi.org/10.1136/jnnp.2007.122879
[15]
Cook, D.J., Mulrow, C.D. and Haynes, R.B. (1997) Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions. Annals of Internal Medicine, 126, 376-380. https://doi.org/10.7326/0003-4819-126-5-199703010-00006
[16]
Honorio, H.M. and Santiago-Jr., J.F. (2021) Fundamentos das Revisões Sistemáticas em Saúde. SP: Santos Publicações.
[17]
Pissini, C.F. (2006) Aplicações em Meta-análise sob um enfoque Bayesiano usando dados médicos. Master’s Thesis, Universidade Federal de São Carlos.
[18]
Petrie, A.S.C. (2001) Compêndio de estatística médica. Instituto Piaget.
[19]
Seebacher, J., Ribeiro, V., LeGuillou, J.L., et al. (1989) Epidural Blood Patch in the Treatment of Post Dural Puncture Headache: A Double Blind Study. Headache: The Journal of Head and Face Pain, 29, 630-632. https://doi.org/10.1111/j.1526-4610.1989.hed2910630.x
[20]
Oedit, R., van Kooten, F., Bakker, S.L.M. and Dippel, D.W.J. (2005) Efficacy of the Epidural Blood Patch for the Treatment of Post Lumbar Puncture Headache BLOPP: A Randomised, Observer-Blind, Controlled Clinical Trial [ISRCTN 71598245]. BMC Neurology, 5, Article No. 12. https://doi.org/10.1186/1471-2377-5-12
[21]
CMNEU (2016) Cosyntropin Versus Epidural Blood Patch (EBP) for Treatment of Treatment of Post Dural Puncture Headache (PDPH). https://clinicaltrials.gov/ct2/show/NCT02394457
[22]
Seebacher, J., Ribeiro, V., Leguillou, J.L., Lacomblez, L., Henry, M., Thorman, F., et al. (1989) Epidural Blood Patch in the Treatment of Post Dural Puncture Headache: A Double Blind Study. Headache: The Journal of Head and Face Pain, 29, 630-632. https://doi.org/10.1111/j.1526-4610.1989.hed2910630.x
[23]
El Dib, R. (2022) Como interpretar uma metanálise? Jornal Vascular Brasileiro, 21, 1-5. https://doi.org/10.1590/1677-5449.202200432
[24]
Pereira, R.S., Santos, I.C., Oliveira, K.D.S. and Leão, N.C.A. (2019) Meta-Analysis as a Research Tool: A Systematic Review of Bibliometric Studies in Administration. Human and Social Management, 20, eRAMG190186. https://doi.org/10.1590/1678-6971/eramg190186
[25]
Monteiro, R.N.M. (2010) Metodologias de meta-análise aplicadas nas ciências da saúde. Master’s Thesis, Universidade da Beira Interior.
[26]
Brasil (2021) Diretrizes metodológicas: Elaboração de revisão sistemática e meta-análise de ensaios clínico randomizados. Brasília-DF: Ministério da Saúde.
[27]
Stannard, D. (2011) Epidural Blood Patching for Preventing and Treating Postdural Puncture Headache. Journal of PeriAnesthesia Nursing, 26, 411-412. https://doi.org/10.1016/j.jopan.2011.09.002
[28]
Orbach-Zinger, S., Azem, K., Heesen, P. and Frenkel, Y.B.A. (2023) Cosyntropin Prophylaxis with Intrathecal Saline: Impact on Post-Dural Puncture Headache and Epidural Blood Patch. Anesthesia, 79, 91-92. https://doi.org/10.1111/anae.16139
[29]
Tubben, R.E., Jain, S. and Murphy, P.B. (2022) Epidural Blood Patch. StatPearls Publ.
[30]
Bradbury, C.L., Singh, S.I., Badder, S.R., Wakely, L.J. and Jones, P.M. (2013) Prevention of Post-Dural Puncture Headache in Parturients: A Systematic Review and Meta-analysis. Acta Anaesthesiologica Scandinavica, 57, 417-430.
[31]
Boonmak, P. and Boonmak, S. (2001) Epidural Blood Patching for Preventing and Treating Post-Dural Puncture Headache. Cochrane Database of Systematic Reviews, 20, 1-32.
